Comparing weight loss outcomes after conversion to Roux-en-Y gastric bypass versus duodenal switch from sleeve gastrectomy in a community hospital

Abstract

Background Recidivism after initial sleeve gastrectomy (SG) remains common. Revisional surgery to convert SG to Roux-en-Y gastric bypass (RYGB) or duodenal switch (DS) for additional weight loss is increasing. This study aims to compare the outcomes after conversion of SG to RYGB or DS. Methods A retrospective single-institution review was conducted from 2015 to 2021, identifying 75 patients who underwent conversion from prior SG to either RYGB (40) or DS (35). Mean excess body weight loss (EBWL) at 3, 6, 12, and 24 months was assessed and compared. Secondary measures of length of stay (LOS), procedure length, and 30-day readmission rate were also reviewed. Results Percentage EBWL for RYGB vs DS was 24.0% vs 18.8% at 3 months ( N = 36 vs 26; P < 0.0491), 34.8% vs 29.0% at 6 months ( N = 29 vs 17; P < 0.2192), 43.0% vs 40.1% at 12 months ( N = 28 vs 12; P < 0.6828), and 36.2% vs 41.7% at 24 months ( N = 27 vs 7; P < 0.5553). Average LOS was 2.6 days ± 1.4 for RYGB and 2.8 days ± 1.3 for DS ( P < 0.6032). Average procedure length was 134.4 min for RYGB and 189.8 min for DS ( P < 0.0001). 30-day readmission rate was 27.5% ( N = 11) for RYGB and 14.3% ( N = 5) for DS ( P < 0.1645). Significant weight loss was observed in both subgroups up to 12 months, with no significant weight loss between 12 and 24 months (RYGB N = 21, P < 0.2961; DS N = 5, P < 0.7233). Conclusion Both revisional RYGB and revisional DS procedures had significant and sustained weight loss in the first 12 months. There was no significant excess body weight loss difference between revisional RYGB and revisional DS patients at 6, 12, and 24 months, with only significant greater weight loss for RYGB patients at 3 months. Additionally, procedure length was significantly longer for DS compared to RYGB, with no significant differences in LOS and 30-day readmission rates. Graphical abstract

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

“…Multiple single-center studies and meta-analyses have compared the weight-loss outcomes between RYGB, SADI, and BPD-DS after initial SG. Jen et al demonstrated that despite having a statistically higher weight loss at 3 months’ follow-up, revisional RYGB did not show a significantly different excess weight loss (%EWL) in the mid- and long-term period compared to BPD-DS after initial SG [ 21 ]. Conversely, other reports describe SADI as having significantly higher short-, mid- and long-term sustained weight-loss results compared to RYGB [ 22 ].…”